Medicaid Fee Schedule without Mods 200801

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PROC-CODE DESC MAC BEG END 35616 BYPASS GRAFT, WITH OTHER THAN VEIN $865.45 20060701 99999999 35621 BYPASS GRAFT, WITH OTHER THAN VEIN $814.87 20060701 99999999 35623 BYPASS GRAFT, WITH OTHER THAN VEIN; AXILLARY-POPLITEAL OR - TIBIAL $876.06 20060701 99999999 35626 BYPASS GRAFT, WITH OTHER THAN VEIN $1,228.67 20060701 99999999 35631 BYPASS GRAFT, WITH OTHER THAN VEIN $1,216.27 20060701 99999999 35636 BYPASS GRAFT, WITH OTHER THAN VEIN $1,059.11 20060701 99999999 35637 BYPASS GRAFT, WITH OTHER THAN VEIN $1,204.55 20070101 99999999 35638 BYPASS GRAFT, WITH OTHER THAN VEIN $1,223.42 20070101 99999999 35641 BYPASS GRAFT, WITH OTHER THAN VEIN $1,255.77 19990701 99999999 35642 BYPASS GRAFT, WITH OTHER THAN VEIN $819.26 20060701 99999999 35645 BYPASS GRAFT, WITH OTHER THAN VEIN $827.68 20060701 99999999 35646 BYPASS GRAFT, WITH OTHER THAN VEIN $1,347.47 20060701 99999999 35647 BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOFEMORAL $1,143.03 20060701 99999999 35650 BYPASS GRAFT, WITH OTHER THAN VEIN $795.97 20060701 99999999 35651 BYPASS GRAFT, WITH OTHER THAN VEIN $1,317.30 20060701 99999999 35654 BYPASS GRAFT, WITH OTHER THAN VEIN $1,032.07 20060701 99999999 35656 BYPASS GRAFT, WITH OTHER THAN VEIN $1,017.18 20060701 99999999 35661 BYPASS GRAFT, WITH OTHER THAN VEIN $738.14 20060701 99999999 35663 BYPASS GRAFT, WITH OTHER THAN VEIN $811.08 20060701 99999999 35665 BYPASS GRAFT, WITH OTHER THAN VEIN $858.41 20060701 99999999 35666 BYPASS GRAFT, WITH OTHER THAN VEIN $1,087.70 20060701 99999999 35671 BYPASS GRAFT, WITH OTHER THAN VEIN $849.41 20060701 99999999 35681 BYPASS GRAFT, COMPOSITE $85.96 20060701 99999999 35682 BYPASS GRAFT; AUTOGENOUS COMPOSITE, TWO SEGMENTS OF VEINS FROM TWO LOCATIONS (LI $387.04 20060701 99999999 35683 BYPASS GRAFT; AUTOGENOUS COMPOSITE, THREE OR MORE SEGMENTS OF VEIN FROM TWO OR M $450.18 20060701 99999999 35685 PLACEMENT OF VEIN PATCH OR CUFF AT DISTAL ANASTOMOSIS OF BYPASS GRAFT, SYNTHETIC $158.10 20060701 99999999 35686 CREATION OF DISTAL ARTERIOVENOUS FISTULA DURING LOWER EXTREMITY BYPASS SURGERY ( $130.77 20060701 99999999 35691 TRANSPOSITION AND/OR REIMPLANTATION; VERTEBRAL TO CAROTID ARTERY $993.84 20060701 99999999 35693 TRANSPOSITION AND/OR REIMPLANTATION; VERTEBRAL TO SUBCLAVIAN ARTERY $721.41 20060701 99999999 35694 TRANSPOSITION AND/OR REIMPLANTATION; SUBCLAVIAN TO CAROTID ARTERY $851.46 20060701 99999999 35695 TRANSPOSITION AND/OR REIMPLANTATION; CAROTID TO SUBCLAVIAN ARTERY $851.24 20060701 99999999 35697 REIMPLANTATION, VISCERAL ARTERY TO INFRARENAL AORTIC PROSTHESIS, EACH ARTERY (LI $120.78 20060701 99999999 35700 REOPERATION, FEMORAL-POPLITEAL OR FEMORAL (POPLITEAL) - ANTERIOR TIBIAL, POSTERIO $165.56 20060701 99999999 35701 EXPLORATION $344.74 20060701 99999999 35721 EXPLORATION $325.09 20060701 99999999 35741 EXPLORATION $323.72 20060701 99999999 35761 EXPLORATION $324.09 20060701 99999999 35800 EXPLORATION FOR POSTOPERATIVE HEMORRHAGE OR $362.49 20060701 99999999 35820 EXPLORATION FOR POSTOPERATIVE HEMORRHAGE OR $600.85 20060701 99999999 35840 EXPLORATION FOR POSTOPERATIVE HEMORRHAGE OR $492.52 20060701 99999999 35860 EXPLORATION FOR POSTOPERATIVE HEMORRHAGE OR $320.79 20060701 99999999 35870 REPAIR OF GRAFT-ENTERIC FISTULA $998.08 20060701 99999999 35875 THROMBECTOMY AND/OR REPAIR OF ARTERIAL OR VENOUS GRAFT $530.37 20060701 99999999 35876 THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT; WITH REVISION OF ARTERIAL OR VENOUS GR $778.71 20060701 99999999 35879 REVISION, LOWER EXTREMITY ARTERIAL BYPASS, WITHOUT THROMBECTOMY, OPEN; WITH VEIN $734.33 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 156
PROC-CODE DESC MAC BEG END 35881 REVISION, LOWER EXTREMITY ARTERIAL BYPASS, WITHOUT THROMBECTOMY, OPEN; WITH SEGM $802.65 20060701 99999999 35883 REVISION, FEMORAL ANASTOMOSIS OF SYNTHETIC ARTERIAL BYPASS GRAFT IN GROIN, OPEN; $884.37 20070101 99999999 35884 REVISION, FEMORAL ANASTOMOSIS OF SYNTHETIC ARTERIAL BYPASS GRAFT IN GROIN, OPEN; $938.83 20070101 99999999 35901 EXCISION OF INFECTED GRAFT; NECK $456.61 20060701 99999999 35903 EXCISION OF INFECTED GRAFT; EXTREMITY $527.44 20060701 99999999 35905 EXCISION OF INFECTED GRAFT; THORAX $1,127.54 20060701 99999999 35907 EXCISION OF INFECTED GRAFT; ABDOMEN $1,246.73 20060701 99999999 36000 INTRODUCTION OF NEEDLE OR INTRACATHETER, VEIN $7.48 20060701 99999999 36002 INJECTION PROCEDURES (EG, THROMBIN) FOR PERCUTANEOUS TREATMENT OF EXTREMITY PSEU $116.30 20060701 99999999 36005 INJECTION PROCEDURE FOR CONTRAST VENOGRAPHY (INCLUDING INTRODUCTION OF NEEDLE OR $38.41 20060701 99999999 36010 INTRODUCTION OF CATHETER $115.98 20060701 99999999 36011 SELECTIVE CATHETER PLACEMENT, VENOUS SYSTEM; FIRST ORDER BRANCH (EG, RENAL VEIN, $135.35 20060701 99999999 36012 SELECTIVE CATHETER PLACEMENT, VENOUS SYSTEM; SECOND ORDER, OR MORE SELECTIVE, BR $157.51 20060701 99999999 36013 INTRODUCTION OF CATHETER, RIGHT HEART OR MAIN PULMONARY ARTERY $119.61 20060701 99999999 36014 SELECTIVE CATHETER PLACEMENT, LEFT OR RIGHT PULMONARY ARTERY $134.86 20060701 99999999 36015 SELECTIVE CATHETER PLACEMENT, EACH SEGMENTAL OR SUBSEGMENTAL PULMONARY ARTERY $157.82 20060701 99999999 36100 INTRODUCTION OF NEEDLE OR INTRACATHETER, CAROTID OR $149.56 20060701 99999999 36120 INTRODUCTION OF NEEDLE OR INTRACATHETER $103.31 20060701 99999999 36140 INTRODUCTION OF NEEDLE OR INTRACATHETER $89.83 20060701 99999999 36145 INTRODUCTION OF NEEDLE OR INTRACATHETER $101.92 20060701 99999999 36160 INTRODUCTION OF NEEDLE OR INTRACATHETER, AORTIC, TRANSLUMBAR $125.41 20060701 99999999 36200 INTRODUCTION OF CATHETER, $143.67 20060701 99999999 36215 INTRODUCTION OF CATHETER, $199.40 20060701 99999999 36216 SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL SECOND ORDER THORACIC OR $225.04 20060701 99999999 36217 SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL THIRD ORDER OR MORE SELEC $271.17 20060701 99999999 36218 SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; ADDITIONAL SECOND ORDER, THIRD OR $43.98 20060701 99999999 36245 INTRODUCTION OF CATHETER, $210.20 20060701 99999999 36246 SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL SECOND ORDER ABDOMINAL, P $228.92 20060701 99999999 36247 SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL THIRD ORDER OR MORE SELEC $270.60 20060701 99999999 36248 SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; ADDITIONAL SECOND ORDER, THIRD OR $44.55 20060701 99999999 36260 INSERTION OF IMPLANTABLE INTRA-ARTERIAL INFUSION PUMP $478.13 20060701 99999999 36261 REVISION OF IMPLANTED INTRA-ARTERIAL INFUSION PUMP $244.97 20060701 99999999 36262 REMOVAL OF IMPLANTED INTRA-ARTERIAL INFUSION PUMP $188.11 20060701 99999999 36299 UNLISTED PROCEDURE, VASCULAR INJECTION $343.20 19990701 99999999 36400 VENIPUNCTURE, UNDER AGE 3 YEARS $11.50 20060701 99999999 36405 VENIPUNCTURE, UNDER AGE 3 YEARS $9.66 20060701 99999999 36406 VENIPUNCTURE, UNDER AGE 3 YEARS $7.17 20060701 99999999 36410 VENIPUNCTURE, CHILD OVER AGE 3 YEARS OR ADULT, NECESSITATING $7.48 20060701 99999999 36415 ROUTINE VENIPUNCTURE FOR COLLECTION OF SPECIMEN(S) $3.00 20060701 99999999 36420 VENIPUNCTURE, CUTDOWN $42.81 20060701 99999999 Hawaii Medicaid Fee Schedule without Mods 01/2008 157
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